Timing and mode of death and impact of starting organ donation in a pediatric intensive care unit: 2016-2024 in Japan.

IF 1 4区医学 Q3 PEDIATRICS

Pediatrics International Pub Date : 2025-01-01 DOI:10.1111/ped.70079

Takanari Ikeyama, Sho Wada, Masako Kawamura, Mihoko Kato

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引用次数: 0

Abstract

Background: There are very few descriptions of end-of-life (EOL) practices from pediatric intensive care units in Japan. Our objective is to describe the mode and timing of death and EOL practices in a tertiary care PICU in Japan.

Methods: This is a retrospective observational study using data from February 2016 to April 2024. Organ donation started locally in 2020. The patients who died in the PICU and were younger than 18 years were included. The mode of death was determined through independent chart review by 2 reviewers. Patient demographic data, care intensity within 24 h before death, length of ICU stay, and interval between consensus on EOL care and death were recorded. Comparisons between before and after starting organ donation were performed.

Results: In total, 77 pediatric deaths were included, and their modes of death were as follows: 48 (62%) cases of limitation of life-sustaining therapy, 11 (14%) of withdrawal of life-sustaining therapy, 12 (16%) of maximal support, and 6 (8%) of DNC. Mechanical ventilation was withdrawn in 82% (9/11) of the withdrawal group. The median and IQR of the interval between EOL consensus and death in our cohort were 12 (4, 23) days. The proportion of patients who died within 2 weeks after the EOL consensus was reached increased after organ donation program initiation (69% vs. 90%, p < 0.05).

Conclusions: Seventy-seven percent of modes of death were either limitation or withdrawal of life-sustaining therapies. More patients died within 2 weeks after the EOL consensus increased after the organ donation program initiation.

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日本儿科重症监护病房开始器官捐赠的死亡时间和模式及其影响：2016-2024年

背景：在日本的儿科重症监护室，很少有关于临终（EOL）实践的描述。我们的目标是描述日本三级护理PICU的死亡模式和时间以及EOL实践。方法：采用2016年2月至2024年4月的回顾性观察研究。2020年，地方开始开展器官捐赠。在PICU中死亡且年龄小于18岁的患者被纳入。死亡方式由2名审稿人通过独立的图表审查确定。记录患者人口学资料、死亡前24 h内的护理强度、ICU住院时间、EOL护理与死亡达成共识的时间间隔。进行器官捐献前后的比较。结果：共纳入77例儿童死亡，死亡方式为：维持生命治疗受限48例（62%），停止维持生命治疗11例（14%），最大支持12例（16%），DNC 6例（8%）。停药组有82%（9/11）停药。在我们的队列中，EOL共识和死亡之间的间隔时间的中位数和IQR为12（4,23）天。器官捐献计划启动后，达成EOL共识后2周内死亡的患者比例增加（69% vs. 90%, p）。结论：77%的死亡方式是限制或停止维持生命的治疗。器官捐献计划启动后，EOL共识增加后2周内死亡的患者较多。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatrics International 医学-小儿科

CiteScore

2.00

自引率

7.10%

发文量

519

审稿时长

12 months

期刊介绍： Publishing articles of scientific excellence in pediatrics and child health delivery, Pediatrics International aims to encourage those involved in the research, practice and delivery of child health to share their experiences, ideas and achievements. Formerly Acta Paediatrica Japonica, the change in name in 1999 to Pediatrics International, reflects the Journal''s international status both in readership and contributions (approximately 45% of articles published are from non-Japanese authors). The Editors continue their strong commitment to the sharing of scientific information for the benefit of children everywhere. Pediatrics International opens the door to all authors throughout the world. Manuscripts are judged by two experts solely upon the basis of their contribution of original data, original ideas and their presentation.